S&C QCOR HHA 2567s
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HHAs 2567s
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Time Interval

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific HHA deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 247019 Bethesda Home Health 1205 Willmar Avenue Se, Suite 155 Willmar MN 5 (Chicago) 07/29/2021 VGJX11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0478 Investigate complaints made by patient Element
G0482 Mistreatment, neglect or abuse Element
G0488 Immediate reporting of abuse by all staff Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
▼ 247019 Bethesda Home Health 1205 Willmar Avenue Se, Suite 155 Willmar MN 5 (Chicago) 01/18/2018 LTUI11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0158 ACCEPTANCE OF PATIENTS, POC, MED SUPER Standard
▼ 247021 Home Care Link 815 Forest Avenue Northfield MN 5 (Chicago) 07/11/2019 ZEMR11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0036 EP Training and Testing Standard
G0572 Plan of care Standard
G0642 Program scope Standard
G0410 Information to patient Element
G0814 Non-skilled direct observation every 60 days Element
▼ 247029 Recover Health Of Minnesota Inc 4602 Grand Avenue, Suite 800 Duluth MN 5 (Chicago) 01/07/2021 UAFB11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0572 Plan of care Standard
G0434 Participate in care Element
G0536 A review of all current medications Element
▼ 247040 Ecumen 4000 London Road Duluth MN 5 (Chicago) 07/10/2025 66663-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0442 Written notice for non-covered care Element
G0580 Only as ordered by a physician Element
▼ 247040 Ecumen 4000 London Road Duluth MN 5 (Chicago) 04/19/2023 5F4DD-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
▼ 247040 Ecumen 4000 London Road Duluth MN 5 (Chicago) 11/08/2019 656O11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0408 Notice of rights Standard
G0572 Plan of care Standard
G0546 Last 5 days of every 60 days unless: Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0722 Participate in HHA-sponsored in-service Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
G1012 Required items in clinical record Element
▼ 247047 Cass Co Public Health Services Box 519, 400 Michigan Avenue Walker MN 5 (Chicago) 04/15/2026 1F344C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0372 Encoding and transmitting OASIS Standard
G0544 Update of the comprehensive assessment Standard
G0514 RN performs assessment Element
G0536 A review of all current medications Element
G0542 Incorporate OASIS items Element
G0574 Plan of care must include the following Element
G0576 All orders recorded in plan of care Element
G0580 Only as ordered by a physician Element
G0808 Onsite supervisory visit every 14 days Element
G1022 Discharge and transfer summaries Element
▼ 247047 Cass Co Public Health Services Box 519, 400 Michigan Avenue Walker MN 5 (Chicago) 09/07/2023 60BC8-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0536 A review of all current medications Element
▼ 247047 Cass Co Public Health Services Box 519, 400 Michigan Avenue Walker MN 5 (Chicago) 03/05/2020 1UZG11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0578 Conformance with physician orders Standard
G0434 Participate in care Element
G0440 Payment from federally funded programs Element
G0488 Immediate reporting of abuse by all staff Element
G0548 Within 48 hours of the patient's return Element
G0574 Plan of care must include the following Element
G0808 Onsite supervisory visit every 14 days Element
G0814 Non-skilled direct observation every 60 days Element
G0818 HH aide supervision elements Element